Management of Hand Injuries: A Systematic Review of Contemporary Surgical and Rehabilitation Strategies

Abstract

Management of traumatic hand injuries has evolved substantially with advances in anesthesia, tendon repair, biological adjuncts, fracture fixation, and rehabilitation. This systematic review synthesizes contemporary evidence on surgical and rehabilitation strategies for improving functional recovery and reducing complications after acute hand trauma. The review was conducted according to PRISMA 2020 and prospectively registered with PROSPERO (CRD420261320700). PubMed/MEDLINE and Cochrane CENTRAL were searched for studies published from January 2000 to May 2026. Randomized controlled trials and prospective comparative studies evaluating contemporary strategies for flexor or extensor tendon injuries and metacarpal or phalangeal fractures were included. Risk of bias was assessed using the Cochrane RoB 2 tool. Owing to substantial clinical and methodological heterogeneity, findings were synthesized narratively. Of 3417 records identified, 354 duplicates were removed and 3063 records were screened. Following full-text assessment, 23 studies were included. Evidence supported the use of wide-awake local anesthesia no tourniquet (WALANT) as a safe alternative to general anesthesia, although functional superiority was not consistent across trials. Acellular dermal matrices, biological amnion, hydrogels, hyaluronic acid, and other adjuncts showed potential for reducing adhesions and improving tendon gliding. Early active mobilization and place-and-hold protocols produced favorable functional outcomes, while relative motion extension orthoses improved early function after extensor tendon repair. Smartphone-assisted rehabilitation improved adherence. Headless compression screws facilitated earlier functional recovery in selected metacarpal fractures, while multistrand tendon repairs provided sufficient strength for early mobilization. Contemporary hand injury management increasingly integrates WALANT, robust tendon repair, anti-adhesion adjuncts, early active rehabilitation, modern orthoses, and digital adherence tools. However, heterogeneity and variable risk of bias across studies warrant cautious interpretation and further high-quality comparative research.